NPIMap

Organization Active NPI

Great Lakes Therapy House Calls PC

Doing business as Great Lakes Physical Therapy Center

  • Physical Therapist
  • Traverse City, MI
National Provider Identifier
1649480674
Registry record updated Feb 19, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Legal business name
GREAT LAKES THERAPY HOUSE CALLS PC
Doing business as
Great Lakes Physical Therapy Center
Practice address
5123 N Royal Dr
Traverse City, MI 49684-9201
Phone
(231) 941-8100
Fax
(231) 941-8812
NPI assigned
May 22, 2007
Last updated
Feb 19, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 19, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
James A Harvey, PT
Title
Administrator
Phone
(231) 941-8100

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Occupational Therapy Assistant 224Z00000X NU
Physical Therapist 225100000X NU Primary

Addresses

Primary practice location

5123 N Royal Dr
Traverse City, MI 49684-9201

Mailing address

1650 Barlow St
Traverse City, MI 49686-4721
Phone (231) 941-8100

Other practice location 1

1105 E 8th St
Traverse City, MI 49686-2936
Phone (231) 941-8110

Other identifiers 2

IdentifierTypeStateIssuer
650B8OtherMIBCBS OF MI
670B8OtherMIBCBS MI

Other names 1

  • GREAT LAKES PHYSICAL THERAPY CENTER Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040311000704 MI Part B Supplier - Clinic/Group Practice 7719876580 Receives reassigned benefits from 3 practitioners
Practice locations: Traverse City, MI
O20120827000773 MI Part A Provider - Outpatient Physical Therapy/Occupational Therapy/Speech Pathology Services 7719876580 1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Traverse City, MI

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

Locations

1105 E Eighth St
Traverse City, MI 49686
Phone (231) 935-6787

1225 W Front St
Ste 2
Traverse City, MI 49684

1650 Barlow St
Traverse City, MI 49686
Phone (231) 941-3100

1650 Barlow St
Ste 11
Traverse City, MI 49686
Phone (231) 941-3100

Ownership & related parties

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Practitioners & affiliated clinicians

Practitioners 16

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 16

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1179792000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1613692800000",
    "number": "1649480674",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1650 BARLOW ST",
            "city": "TRAVERSE CITY",
            "state": "MI",
            "postal_code": "496864721",
            "telephone_number": "231-941-8100",
            "fax_number": "231-922-0382"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5123 N ROYAL DR",
            "city": "TRAVERSE CITY",
            "state": "MI",
            "postal_code": "496849201",
            "telephone_number": "231-941-8100",
            "fax_number": "231-941-8812"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1105 E 8th St",
            "address_purpose": "LOCATION",
            "city": "Traverse City",
            "state": "MI",
            "postal_code": "496862936",
            "country_code": "US",
            "telephone_number": "231-941-8110",
            "fax_number": "231-941-8812",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "GREAT LAKES THERAPY HOUSE CALLS PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-22",
        "last_updated": "2021-02-19",
        "certification_date": "2021-02-19",
        "status": "A",
        "authorized_official_last_name": "HARVEY",
        "authorized_official_first_name": "JAMES",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "231-941-8100",
        "authorized_official_credential": "PT"
    },
    "taxonomies": [
        {
            "code": "224Z00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapy Assistant",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF MI",
            "identifier": "650B8",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS MI",
            "identifier": "670B8",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "GREAT LAKES PHYSICAL THERAPY CENTER",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Traverse City, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 19, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.